They tell us the prevalence of HIV in Haiti is 3-4%, and minimally higher in our hospital. None of us believe this.

I was pulled to work on our Emergency Room today because of the overflow of patients and lack of doctors. My first patient is a 60y mother, lives alone, who was complaining of increased abdominal girth that has occurred over the last 8 days - 9 months, depending on which interpreter I used.

Examining her, I found huge lymph nodes all over her body, a dress that appeared 4 sizes too big, thrush (a white funus infection on the tongue), a large spleen and liver, and shingles on her back.

We actually have the blood test available, but it wasn't necessary to diagnose her with HIV, actually AIDS, very advanced.

I have a psychologist with whom I work, but we don't know the culture: their shame, their secrets, their trust. She (the psychologist) and I explained (through a very poor interpreter) to the patient that she has a virus, what it means to her now and in the long run, and how taking medications could make her live a lot longer (if she's willing and able to take them).

She chose to keep this a secret from her sister and son who were there with her. We referred her to the only HIV clinic in Port-au-Prince. I would be surprised if she goes. I would be very surprised if she sees the fall, let alone 2011.